Real-world effectiveness of admissions to a tertiary treatment-resistant psychosis service: 2-year mirror-image study

Journal article


Cecilia Casetta, Fiona Gaughran, Ebenezer Oloyede, Juliana Onwumere, Megan Pritchard, Sukhi S. Shergill, Eromona Whiskey and James Hunter MacCabe 2020. Real-world effectiveness of admissions to a tertiary treatment-resistant psychosis service: 2-year mirror-image study. BJPsych Open. 6 (5), p. E82. https://doi.org/10.1192/bjo.2020.51
AuthorsCecilia Casetta, Fiona Gaughran, Ebenezer Oloyede, Juliana Onwumere, Megan Pritchard, Sukhi S. Shergill, Eromona Whiskey and James Hunter MacCabe
Abstract

Background
Treatment-resistant schizophrenia is a major disabling illness which often proves challenging to manage in a secondary care setting. The National Psychosis Unit (NPU) is a specialised tertiary in-patient facility that provides evidence-based, personalised, multidisciplinary interventions for complex treatment-resistant psychosis, in order to reduce the risk of readmission and long-term care costs.

Aims
This study aimed to assess the long-term effectiveness of treatment at the NPU by considering naturalistic outcome measures.

Method
Using a mirror image design, we compared the numbers of psychiatric and general hospital admissions, in-patient days, acuity of placement, number of psychotropic medications and dose of antipsychotic medication prescribed before and following NPU admission. Data were obtained from the Clinical Records Interactive Search system, an anonymised database sourced from the South London and Maudsley NHS Trust electronic records, and by means of anonymous linkage to the Hospital Episode Statistics system.

Results
Compared with the 2 years before NPU admission, patients had fewer mental health admissions (1.65 ± 1.44 v. 0.87 ± 0.99, z = 5.594, P < 0.0001) and less mental health bed usage (335.31 ± 272.67 v. 199.42 ± 261.96, z = 5.195 P < 0.0001) after NPU admission. Total in-patient days in physical health hospitals and total number of in-patient days were also significantly reduced (16.51 ± 85.77 v. 2.83 ± 17.38, z = 2.046, P = 0.0408; 351.82 ± 269.09 v. 202.25 ± 261.05, z = 5.621, P < 0.0001). The reduction in level of support required after treatment at the NPU was statistically significant (z = −8.099, P < 0.0001).

Conclusions
This study demonstrates the long-term effectiveness of a tertiary service specialising in treatment-resistant psychosis.

KeywordsTreatment resistant psychosis; Tertiary service; Personalised care; Clozapine; Specialist service
Year2020
JournalBJPsych Open
Journal citation6 (5), p. E82
PublisherCambridge University Press
Royal College of Psychiatrists
ISSN2056-4724
Digital Object Identifier (DOI)https://doi.org/10.1192/bjo.2020.51
Official URLhttps://doi.org/10.1192/bjo.2020.51
Publication dates
Print03 Aug 2020
Publication process dates
Deposited12 Jun 2023
Publisher's version
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